Clinical Insurance Officer

Ghobash Group; Abu Dhabi; On-site; AED 120,000 - 200,000; Full time

Job summary

A healthcare provider in Abu Dhabi seeks a Clinical Insurance Officer to manage insurance-related processes for home healthcare patients. The successful candidate will be responsible for obtaining pre-authorizations, coordinating with insurance companies, and ensuring compliance with payer guidelines. Essential qualifications include a Bachelor's degree in Nursing and at least 2 years of experience in a similar role. This is a full-time position and remote work is not available.

Qualifications

• Minimum of 2 years of experience in a similar role.
• Advanced understanding of medical terminology and administration processes.

Responsibilities

• Obtain, monitor, and renew insurance pre-authorizations.
• Coordinate with insurance companies to secure approvals.
• Ensure compliance with DOH and payer requirements.
• Track patient hospital admissions and discharges.

Skills

Medical terminology

Administration processes

Education

Bachelor of Nursing

Job description

Summary

The Clinical Insurance Officer is responsible for managing all insurance-related processes for home healthcare patients including pre-authorizations, renewals, and claim documentation. The role ensures that all clinical and administrative requirements are met in compliance with payer guidelines, Department of Health (DOH) standards, and internal policies.

Roles & Responsibilities

• Obtain, monitor, and renew insurance pre-authorizations for all home care services (e.g., nursing, physiotherapy, medical and multidisciplinary care).
• Verify patient insurance eligibility and coverage before initiating or renewing services.
• Coordinate with insurance companies and third‑party administrators (TPAs) to secure approvals and address pending or rejected requests.
• Liaise with physicians and clinical staff to complete and submit all required medical reports and treatment plans.
• Ensure all insurance forms, including DAMAN Forms (PAFs, progress notes, medical reports) are properly signed, stamped, and compliant with DOH and payer requirements.
• Track authorization validity to prevent service interruptions for active patients.
• Score medical condition and services for new and established patients.
• Follow up with insurance companies regarding required reports or information.
• Determine the correct codes for patient records.
• Prepare all reports and documents required by insurance companies for pre‑approval, including collection and arrangement of face‑to‑face consent forms, licenses of nurses, physiotherapy & doctor nursing care plans, physiotherapy plans, and assessment scoring grids.
• Review clinical documentation to ensure it supports medical necessity for services billed to insurance.
• Verify that patient records, including Periodic Assessment Forms (PAFs) and treatment notes, align with the approved authorization scope and duration.
• Identify incomplete or inconsistent documentation and coordinate with clinicians for prompt correction Dengong
• Keep track of patient hospital admissions, ER visits, and discharges.
• Prepare monthly reports on patient movement (daman allocation, admission, and discharge).
• Submit daily staff capacity to daman.
• Prepare and submit JAWDA KPI reports and act as JAWDA KPI data collector.
• Collect and save all KPI reports.
• Perform other duties as assigned by management.

Qualifications

• Bachelor of Nursing
• 2 years of experience in a similar role
• Advanced understanding of medical terminology and administration processes

Remote Work

No

Employment Type

Full‑time